Provider Demographics
NPI:1730757725
Name:HAGANMAN, KYLE CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:HAGANMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 38TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4300
Mailing Address - Country:US
Mailing Address - Phone:319-365-0534
Mailing Address - Fax:319-297-7417
Practice Address - Street 1:815 38TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4300
Practice Address - Country:US
Practice Address - Phone:319-365-0534
Practice Address - Fax:319-297-7417
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-098981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice